Change is on the horizon for spinal cord injury patients to receive Medicaid coverage for massage therapy services.
A pilot study in Colorado has paved the way for this underserved population to receive the benefits of massage therapy.
Now the state is looking for massage therapists to apply to become providers for their services, which are reimbursed by Medicaid.
There are an estimated 17,700 new spinal cord injury cases every year in the U.S. and approximately 288,000 people in the country are living with a spinal cord injury, according to the National Spinal Cord Injury Statistical Center (NSCSC) 2018 report.
The main cause of spinal cord injury are car accidents, acts of violence involving guns and recreational and sport activities.
How Massage Helps Spinal Cord Injury Patients
Research has found that this population can benefit greatly from routine massage therapy and other integrative therapies, including chiropractic and acupuncture. Considering the health care costs and lifestyle changes that spinal cord injury patients have already the additional cost for these services can be out of reach.
Colorado’s Medicaid program, Health First Colorado, offers spinal cord injury patients coverage for complementary health services including massage therapy, chiropractic and acupuncture through their Home and Community Based Services SCI (Spinal Cord Injury) waiver program. The SCI waiver reimburses approved massage therapy providers $57.36 for a one-hour massage to spinal cord injury patients in the program.
To become a provider, massage therapists must be registered with the Department of Regulatory Agencies and hold licensure and certification for at least two years prior to submission of their application.
The pilot study found that 75 percent of patients who received these services had a reduction in pain, over 25 percent lowered their pain medication dosages and 100 percent of patients recommend the services, according to a 2017-2018 report prepared by National Research Center Inc., a third-party evaluator of the SCI waiver program.
How the SCI Waiver Came to Be
Chanda Hinton-Leichtle, executive director and founder of The Chanda Plan Foundation, spearheaded the legislation for the SCI waiver. Hinton-Leichtle became a quadriplegic at the age of 9 after being accidentally shot. Years of pain medication took its toll on her and at 21 years old, her health deteriorated. She was hospitalized and medical intervention was necessary to save her life. She recovered with a new mindset and mission.
“Once I was better, they said to go back to what I was doing before but that would have kept me in that vicious cycle of needing medical intervention to save my life again,” says Hinton-Leichtle.
She was led to massage, chiropractic and acupuncture by her sister and she saw incredible improvements in her health. However, these services were not covered by Medicaid and her family used personal credit cards to continue her care. She was determined to find a way to have these services covered by Medicaid for her population.
Hinton-Leichtle started the dialogue and became an advocate for the SCI waiver. It passed into legislation in 2009 and the pilot study for the program began.
“The benefits are huge. As a massage therapist, you know the benefits of massage so imagine when you are dealing with someone who spends their lifetime in a chair. The benefits of being on the massage table and having their muscles worked over, even those muscles they are not using being worked over, it’s very beneficial for them,” says Jay Seller, PhD, executive director of NeuAbility in Denver, Colorado, who has been a provider with the program since its beginning.
NeuAbility is entering its 11th year in the SCI waiver program. The clinic sees between 30 and 50 spinal cord injury clients a week for adaptive exercise and rehabilitation and integrative therapy. Aimee Godin, LMT with NeuAbility says working with this population is humbling. She uses Thai massage, deep tissue, stretching, cupping and other massage therapy modalities with her SCI clients.
“When I first started, I was a year out of massage school and I had never worked with this population before,” says Godin. “I was intimidated and now I am constantly humbled. I love working there and seeing the changes that massage has on this population.”
Benefits and Barriors of the SCI Waiver
The SCI Waiver provides Medicaid coverage for massage, acupuncture and chiropractic services to spinal cord injury patients. Patients with access to these services experience an improved quality of life, reduction in pain, reduction of pain medication and most of all hope.
“The SCI Waiver has really helped me to have the energy to handle the things I need to deal with in my life,” says James, a SCI waiver client at NeuAbility. James receives weekly massage and acupuncture since he enrolled in the program in 2013. “It was an easy decision for me. I knew I could benefit from the services.”
The SCI waiver has the potential to make a great impact on the quality of life for the spinal cord injury population, but there are barriers limiting the access to these services.
Providers must apply and be approved for the program in order to receive reimbursement. The reimbursement process can be cumbersome for an individual provider.
“There is a learning curb with providers,” Hinton-Leichtle says. Providers must learn how to submit the medical billing paperwork properly in order to be approved for reimbursement and be able to wait for payment after services are given. Providers like The Chanda Plan Foundation and NeuAbility have a staffed medical billing employee that is trained in the process.
However, individual providers will likely be submitting the medical billing form themselves and will need to receive additional training on how to do so correctly in order to receive reimbursement from Medicaid. They are not reimbursed for administrative time required to submit the billing and additional paperwork regarding treatments for clients. Reimbursement for made only for the massage service.
“The more difficult part is learning how to deal with the Medicaid billing situation. If that was fixed, it would be a lot easier to take on clients,” Seller says.
The best scenario for a massage therapists looking to work with the SCI waiver program is to have a financial buffer to get them through the reimbursement time, which can take about 30 days from the time the reimbursement paperwork is submitted, and be trained in the medical billing process for this program, advises Hinton-Leichtle.
She is exploring solutions around the billing barrier for individual providers and her organization is open to act as a third-party vendor for medical billing for individual providers working with the SCI waiver program. Her mission is to remove the barriers so that more providers would be willing to work with spinal cord injury clients of this program.
“SCI patients gain access to preventative care at no cost because it is funded by Medicaid. But if we don’t have enough providers, what is the point of creating the waiver and funding it when patients won’t actually have access to the benefits,” says Hinton-Leichtle.
Individual massage providers will also have to invest in a massage table with an electric lift and learn how to move SCI clients from their chairs to the table and from prone to supine. It’s not impossible but will take extra effort.
A Big Opportunity for Massage Therapists
The Chanda Plan Foundation sees approximately 128 SCI clients weekly; of those, 60 come just for massage. The organization believes this is a big opportunity for massage therapists to jump on board at the beginning of a program that is making waves in the spinal cord injury population.
Massage therapists seeking to work with patients doing rehab work with spinal cord injury clients and gain medical massage experience are encouraged to apply.
“Every client has something to teach you. If it’s something that is calling you, I would say 100 percent, go and learn from this population,” Godin says.
If you are interested in becoming a massage therapy provider for the SCI waiver program, follow these steps and visit Health First Colorado’s Home & Community Based Services (HCBS).
Step 1- 1.5: Massage therapist providers enroll as Type 36 for Home and Community Based Services. Determine the provider specialty for HCBS. The one discussed in this article is the 638 – Complementary and Integrative Health SCI Waiver. However, there a multiple specialties that a provider may enroll as a massage therapist which include: 613 – Children with Life Limiting Illness – Massage Therapy CLLI waiver, 729 – Professional Services – Massage – Children’s Extensive Support (CES) and Supported Living Services (SLS) waiver.
Step 2: Download the enrollment checklist for “Atypical – HCBS.”
Step 3: Review the Provider Enrollment Manual and take the Provider Enrollment Training. After reviewing these materials, begin the application.
Step 4: Next steps after you have submitted your application, including information on notifications and how to check the status.
Aiyana Fraley, LMT, is a freelance writer and health care professional with more than 17 years of experience in the massage field. She teaches yoga and offers sessions in massage, Reiki, sound healing and essential oils. Her articles for massagemag.com include “Advanced Massage Training Will Take Your Career to the Next Level — Just Ask These Massage Therapists” and “The Massage Therapist’s Guide to Assisted Stretching Techniques.”